Purpose:
To identify any anatomical retinal changes that develop after spontaneous acute posterior vitreous detachment (PVD) and compare it to previously reported findings following ocriplasmin induced release of vitreomacular traction.

Methods:
Prospective single center study of patients with signs and symptoms (flashers and floaters) of acute PVD less than 2 weeks duration, and confirmed by funduscopic examination. An enhanced vitreous imaging spectral-domain optical coherence tomography (SD-OCT) protocol was implemented for patients who presented with the above symptoms. Patients received both a 6-line radial and a 7-line raster scan pattern using a scan width of 30° centered on the fovea. This imaging protocol was performed on both the symptomatic eye and the corresponding fellow eye. SD-OCT scans were then reviewed to detect any retinal changes, specifically in the external limiting membrane and ellipsoid zone. The findings were then compared to the fellow eye.

Results:
Forty eyes of 40 patients with a mean age of 59 ± 10 years were included in this study. The presence of PVD was confirmed by enhanced vitreous SD-OCT imaging in all cases. The ellipsoid zone and external limiting membrane were found to be intact in all 40 cases following spontaneous release of the vitreomacular interface. Similarly, no outer retinal changes were noted in the fellow eye. Nine of the 40 patients had a retinal tear detected on funduscopic examination. Seven of these 9 patients demonstrated hyperlucent dots within the region of detached vitreous.<br />

Conclusions:
Spontaneous acute PVD does not seem to cause ellipsoid zone changes as is noted in patients that undergo release of vitreomacular traction using intravitreal ocriplasmin injections.This suggests that the mechanism of ellipsoid zone changes following ocriplasmin injection may be a result of the pharmacological action of the drug. Furthermore, the presence of hyperlucent dots in the region of detached vitreous in patients with acute PVD, may be a sensitive indicator for the presence of a retinal tear.